Open reduction and corrective ulnar osteotomy for missed radial head dislocations in children

Abstract

The treatment of chronic radial head dislocation remains controversial. Open reduction of the radial head in combination with correction of malalignment with ulnar osteotomy can be the key to a good surgical result. Between 2001 and 2006, 9 (6 female, 3 male, average age 8.4 (5-11) years) patients were treated surgically for chronic radial head dislocation by one surgeon. The time between trauma and surgery was 7 (1.5-14) months. The procedure consisted of open reduction of the dislocated radial head and reconstruction of the annular ligament in combination with an ulnar osteotomy. An upper arm cast was applied with the forearm in neutral rotation for six weeks. Plates were removed in all patients. Clinical and radiological evaluation took place preoperatively and after an average of 23 (10-49) months. At radiograph 8/9 showed a reduced radial head; in one an anterior subluxation was seen. The range of motion remained the same in 4 patients who had a full range of motion preoperatively. In 2/5 patients with loss of range of motion preoperatively, improvement was seen. There were no serious surgical complications beside one infection. Open reduction and corrective ulnar osteotomy shows good results for missed radial head dislocations in children.

Rare Cause of Block to Reduction After Radial Head Dislocation in Children

“…Radiographs must be evaluated carefully after radial head dislocation in children to ensure that plastic deformity of the ulna is not present because this injury is commonly missed. Numerous recent series [3][4][5][6][7][8] have been published that document successful treatment of undiagnosed Monteggia fracture-dislocation e40 | www.jorthotrauma.com injuries in children through an osteotomy of the ulna and radial head reduction but none described an extracapsular dislocation of the radial head.…”

Paediatric Radial Head Dislocation with Associated Ulnar Pathology

“…The ulnar bowing is facilitated by the plasticity of the ulna in children hence the bone may undergo significant bending without fracturing [5]. Plastic bony resilience distinguishes children from adults, hence why the adult will more likely suffer an associated displaced ulna fracture [2]. The usual mechanism of injury is a fall on the outstretched hand with the elbow fully extended and the forearm pronated with a strain applied to the elbow [1,6].…”

“…Plastic deformation should be suspected in children presenting with deformity but has no radiological evidence of a fracture [2]. Also, the radiocapitellar line (to assess for radiocapitellar dislocation) and the ulnar bow sign should routinely be radiologically assessed.…”

“…Reports of isolated radial head dislocations in the literature have been intermittent and consisting of case reports or small case series whereby impressions have often been inconclusive [7]. Diagnosis is best made radiographically with a true lateral X-Ray showing the elbow and wrist joints [2].…”

“…Radial head dislocations with associated ulna pathology are rare injuries, but they are far more common than isolated radial head dislocations [1,2]. Although the vast majority of acute paediatric upper extremity fractures and dislocations are successfully treated by closed means, certain injuries will require operative management.…”